Pigmentation spots and uneven skin tone

Pigmentation spots appear when our skin gathers more natural pigment in some areas than the others. This is called "hyperpigmentation" (from "hyper" = "excessive", "more than normal").

Can topical skincare help?** **Yes, but there is no one "silver bullet". You need to build a good skincare regimen and stick to it for a couple of months to get good results. And yes, you will need to use a proper sunscreen daily ☀️. Keep on reading to learn more.

Why does hyperpigmentation happen?

Pigmentation spots can appear because of a few different reasons:

"Errors" in the natural skin pigment (melanin) production and storage because of sun damage accumulated over time. In other words, photo aging.
Results of a skin trauma. Areas of the old skin traumas often get darker than the rest of the skin. This can happen after acne spots, insect bites, ingrown hair, cuts, scratches, burns, irritant or allergic skin reactions, eczema flairs, overdone cosmetic peels and other procedures like laser skin treatments.
Hormonal changes. Uneven pigmentation can appear in or after pregnancy, with start of hormonal contraceptions or in menopause. Symmetrical areas of hormones-related hyperpigmentation are often diagnosed as "melasma".
Side-effects of oral medication.

**Regardless of the underlying reason, sun radiation is always the trigger for the pigmentation. **

The less sun exposure your skin gets, the less likely you are to get pigmentation issues from the causes above. (And the less sun exposure you get, the less dark the pigmented areas will be if you get them).

All skin tones can suffer from uneven pigmentation, but it is more frequent and more visible in darker skin. It also often takes longer to see improvements from anti-pigmentation regimen for darker skin.

The skin pigment, melanin, is in both the top layer of our skin (epidermis) and in the deeper one (dermis). Pigmentation spots often affect the both layers of the skin. If the pigmentation spot has a bluish undertone, it is a sign that it originates in the deeper layer of the skin. This type of pigmentation spots takes longer to heal.

What skincare can help with hyperpigmentation?

Here is what you need in terms of skincare to reduce pigmentation spots:

A daily broad spectrum **sunscreen **with SPF 30 or more.
A lot of patience: it usually takes 3 to 12 months to see good results from anti-pigmentation topical skincare.
1-3 topical skincare actives used regularly that help reduce melanin production and/or storage (see below).
Gentle chemical exfoliation 1-2x a week if you'd like to speed up the process and your skin is resilient enough to tolerate it. You do not want to overdo it with your anti-pigmentation actives and exfoliants. They can lead to irritation (and irritation, in turn, can trigger more pigmentation).

Top anti-pigmentation actives

Skincare actives that targets pigmentation can work in a few different ways. Some ingredients can get make skin cells produce less melanin. Actives like Hydroquinone, Arbutin, Kojic Acid, Azelaic Acid, Tranexamic Acid work this way (in dermatology, they are called "tyrosinase-inhibitors"). Other actives, like Niacinamide can make skin store less melanin. Anti-oxidants like Ascorbic Acid help reduce the damage skin gets from sun exposure and reduce melanin production this way (it also works a tyrosinase inhibitor). Chemical exfoliants like Glycolic or Lactic Acids remove the surface layer of the skin cells. This way skin gets to shed the cells with bigger melanin deposits faster. Retinoids help reduce pigmentation in a few different ways at once.

Overall, it is a good idea to combine 2-3 different anti-pigment actives in your regimen. Important warning: do not overdo it with actives and exfoliation. You want to avoid skin irritation, because irritation on its own can result in more pigmentation. This is especially important if your natural skin tone is dark.

UV filters & sunscreens

No matter the cause of the pigmentation, a daily sunscreen is the most important product in the anti-pigmentation skincare routine. It is important that your sunscreen includes a combination of UV filters that together protect from both UVB ("burning") and less noticeable UVA rays. The minimum recommended SPF is 30.

Niacinamide

Vitamin B3. It is one of the safest potent anti-pigment actives: it very rarely leads to irritation. On the contrary, in addition to reducing pigmentation, it strengthens the skin barrier and has an anti-aging and anti-acne benefit. It can be used 2x a day. The concentrations of 2-6% are effective for pigmentation issues.

Retinoids

Retinoids work against unwanted pigmentation in the two main ways:

They suppress the activity of the enzyme tyrosinase that kicks off the production of melanin (the skin pigment).
They increase the cell turnover and this results in lighter skin getting to the surface.

If you are dealing with post-acne pigmentation, retinoids are particularly great actives. They work both against the active acne spots, prevent the new ones, and treat post-acne marks at the same time.

To see results, you'll need to use a retinoid product regularly a few times a week up to daily for a couple of months to see results.

Skin irritation is a very common side-effect of retinoids. If your skin is sensitive, use a product with retinoid only 1-2 times a week, especially when you are just starting. With time, you might be able to increase the frequency. Read our Retinoids for Hyperpigmentation to learn more.

Thiamidol

On product ingredient lists, this active appears as Isobutylamido Thiazolyl Resorcinol. It was discovered and is patented by Beiersdorf, the parent company of skincare brands Eucerin and Nivea. It is the newest available anti-pigmentation active with solid research on its efficacy. While more studies are still needed, it appears to be one of the most potent anti-pigment actives (tyrosinase inhibitors) among ingredients available in cosmetic skincare today. The research available shows that Thiamidol is as effective as Hydroquinone, but is safer (side effects from Hydroquinone can be significant and we do not recommend using it without a doctor's supervision). Thiamidol can be used 1x or even multiple times daily (up to 4). It seems to be usually well tolerated, but irritation from it is still possible.

Alpha-Arbutin

It is a safer relative of Hydroquinone. It is a synthetic ingredient. Sometimes it is called alpha-Arbutin to differentiate it from the natural form of Arbutin (beta-Arbutin) which is less effective against pigmentation.

Alpha-Arbutin is an effective anti-pigment active when used in concentrations around 2%. It can be used daily, but it can be irritating.

Ascorbic Acid

Vitamin C. It is the most potent and well-studied anti-oxidant in skincare. It is effective for reducing pigmentation and has an anti-aging benefit. You need the concentration of 10% or higher to see the results. Ascorbic Acid in this concentration can be irritating. Be mindful of this risk when adding it to your routine, especially if you are using other anti-pigmentation actives like Retinoids, Thiamidol, Arbutin or Kojic Acid. You can use a serum with Ascorbic Acid in the AM or PM; every day or less frequently if your skin is sensitive. Ascorbic Acid is unstable and loses effectiveness on contact with air, light and high temperature. If your Ascorbic Acid changes its color and turned yellow / orange, it means that the Ascorbic Acid in it already lost some of its effectiveness. Use up products with Ascorbic Acid quickly after opening.

Azelaic Acid

Azelaic Acid is present in our skin naturally. It is produced by normal skin’s microbiome. It has both an anti-pigmentation and anti-inflammatory effect. This makes it a great active for helping with melasma, as well as treating acne and pigmentation at the same time. It is also used for treating rosacea. The ideal concentration for an anti-pigmentation routine is between 10% and 20%. It rarely causes irritation, but the risk is higher if you are using more than 10%.

Kojic Acid

It is compound that is produced by fungi or can be synthesized in a lab. It is shown to be effective in reducing pigmentation when used in concentration of 2% and higher in combination with other anti-pigment treatments like, for example, a weekly peel with 10% Glycolic Acid. Unfortunately, irritation is a common side-effect with Kojic Acid. We do not recommend using it long term (longer than 1 year). Another issue with Kojic Acid is that concentrations only up to 1% are seen as safe in cosmetics by many regulators, and the studies use 2% concentration or higher.

Exfoliating Acids

Glycolic, mandelic, lactic acid (called AHAs, or alpha-hydroxy acids), lactobionic acid, gluconalactone (called PHAs, or polyhydroxy acids) can help speed up fading of the pigmentation spots. These acids remove the surface layer of the skin cells. This way skin gets to shed the cells with bigger melanin deposits faster.

Exfoliating acids have a major side effect. They thin the upper layer of the skin, and it can make the skin reactive. It can get irritated easier. Skin irritation can trigger more pigmentation, so you definitely want to avoid it.

People whose skin isn't sensitive can usually use an exfoliant with 10-15% of total concentration of exfoliating acids 1-2 times a week. The more other potentially irritating active you use in a routine, the less frequently you should exfoliate. The lower the concentration of the acids is, the smaller is the risk of irritation.